Low-energy surface acoustic waves generated from electrically activated piezo elements are shown to effectively prevent microbial biofilm formation on indwelling medical devices. The development of biofilms by four different bacteria and Candida species is prevented when such elastic waves with amplitudes in the nanometer range are applied. Acoustic-wave-activated Foley catheters have all their surfaces vibrating with longitudinal and transversal dispersion vectors homogeneously surrounding the catheter surfaces. The acoustic waves at the surface are repulsive to bacteria and interfere with the docking and attachment of planktonic microorganisms to solid surfaces that constitute the initial phases of microbial biofilm development. FimH-mediated adhesion of uropathogenic Escherichia coli to guinea pig erythrocytes was prevented at power densities below thresholds that activate bacterial force sensor mechanisms. Elevated power densities dramatically enhanced red blood cell aggregation. We inserted Foley urinary catheters attached with elastic-wave-generating actuators into the urinary tracts of male rabbits. The treatment with the elastic acoustic waves maintained urine sterility for up to 9 days compared to 2 days in control catheterized animals. Scanning electron microscopy and bioburden analyses revealed diminished biofilm development on these catheters. The ability to prevent biofilm formation on indwelling devices and catheters can benefit the implanted medical device industry.Indwelling device-related infections constitute a major cause of morbidity and mortality in hospitalized patients, adding considerably to medical costs. Microbial biofilms readily develop on all types of devices, urinary, endotracheal, intravenous, and other types of catheters and implants inserted into more than 25% of patients during hospitalization. The incidence of bacterial infections in patients with urinary catheters is approximately 5 to 10% per day, with virtually all patients who undergo long-term catheterization (Ն28 days) becoming infected (13,14,17).The first stage in biofilm formation from planktonic microorganisms is attachment to solid surfaces (6). Attachment stimulates microbial aggregation and proliferation to form microcolonies. The colonies excrete an encasing exopolysaccharide "slime," which consolidates the attachment to surfaces, and the microaggregates differentiate into characteristic biofilms (20). Quorum-sensing molecules that generate concentration gradient-dependent signals that control and alter expression of a large number of genes also aid biofilm differentiation (15,25). Encasing the extracellular polysaccharide matrix of biofilms regulates exchange of ions and nutrients with the surrounding environment. This regulation contributes to increases of up to 1,000-fold in biofilm resistance to antibiotics compared to planktonic bacteria (9, 11) and protects the biofilms from biocides, surfactants, and predators. Microbial biofilms also present serious challenges to the immune system because expression of bac...

Microbial biofilms are a major impediment to the use of indwelling medical devices, generating device-related infections with high morbidity and mortality. Major efforts directed towards preventing and eradicating the biofilm problem face difficulties because biofilms protect themselves very effectively by producing a polysaccharide coating, reducing biofilm sensitivity to antimicrobial agents. Techniques applied to combating biofilms have been primarily chemical. These have met with partial and limited success rates, leading to current trends of eradicating biofilms through physico-mechanical strategies. Here we review the different approaches that have been developed to control biofilm formation and removal, focusing on the utilization of acoustic energy to achieve these objectives.